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The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv

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Tri-Ethnic Center for Prevention Research. Red Road. Prairielands ATTC ... Discuss prevention theory and models ... Matrix Model (combination of above) (Data ... – PowerPoint PPT presentation

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Title: The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv


1
The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Methamphetamine Problems Development of Native
Prevention Models
Dale Walker, MD Patricia Silk Walker, PhD
Michelle Singer Laura Loudon, MS Doug
Bigelow, PhD July 24, 2007
Phoenix, Arizona
2
Native Communities
Advisory Council / Steering Committee
One Sky Center
3
One Sky Center Partners
Tribal Colleges and Universities
Cook Inlet Tribal Council
Alaska Native Tribal Health Consortium
Prairielands ATTC
Red Road
Northwest Portland Area Indian Health Board
One Sky Center
Harvard Native Health Program
United American Indian Involvement
Jack Brown Adolescent Treatment Center
National Indian Youth Leadership Project
Tri-Ethnic Center for Prevention Research
Na'nizhoozhi Center
4
Presentation Overview
  • Whats the story on methamphetamine?
  • Discuss prevention theory and models
  • Integrated care approaches and interagency
    coordination are best overall solutions

5
Methamphetamine Abuse Eastward Movement Based on
Hospital Admissions
6
Arizona Methamphetamine Admissions
Governors Council on Addictions 2006
7
Oregon Methamphetamine Admissions
8
OHSU Substance Abuse Clinic Enrollees
9
National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
10
National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
11
Methamphetamine Epidemiology
12
Methamphetamine Use in 2004
Percentage
Source SAMHSA 2004 NSDUH.
13
IHS-Wide Outpatient Encounters for Amphetamine
Related Visit by Calendar Year
14
Lifetime, Past Year, and Past Month
Methamphetamine Use
Richard Kopanda, CSAT
a Significant change 2003 to 2004 b
Significant change 2002 to 2004
15
Why is Methamphetamine so Devastating?
  • Cheap, readily available
  • Stimulates, gives intense pleasure
  • Damages the users brain
  • Paranoid, delusional thoughts
  • Depression when stop using
  • Craving overwhelmingly powerful
  • Brain healing takes up to 2 years
  • We are not familiar with treating it

16
Native Adolescents Multiple Life Risks
Psychiatric Illness Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance Use/Abuse
Hopelessness
Family Disruption Domestic Violence
CHILD
Family History
Negative Boarding School
Psychodynamics/ Psychological Vulnerability
Historical Trauma
Suicidal Behavior
17
Adolescent Problems In Schools
Alcohol Drug Use
Fighting and Gangs
Bullying
Weapon Carrying
School Environment
Sale of Alcohol and Drugs
Sexual Abuse
Unruly Students
Truancy
Attacks on Teachers Staff
Domestic Violence
Drop Outs
12
18
Methamphetamine, Why Now?
  • The Internet
  • Diffused local production, less reliance on
    imports
  • Multi-drug use no one uses only crystal
  • National outbreak
  • Varied sub-populations
  • More smoking
  • Strong association with HIV, hepatitis C
  • Community level responses to AIDS deaths, 9/11,
    war
  • National discussion

19
The Methamphetamine Effect
20
Difficulties of System Integration
  • Separate funding streams and coverage gaps
  • Agency turf issues
  • Different philosophies
  • Lack of resources
  • Poor cross training
  • Consumer and family barriers

21
(No Transcript)
22
Developmental Paths for Multi-Problem Behavior
Dennis D. Embry
23
The Intervention Spectrum for Behavioral
Disorders
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Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
24
Prevention Theory
  • Explains the causes and mechanisms of
    action
  • Identifies the variables influencing these
  • mechanisms, including cultural
  • Predict points to interrupt the course
    leading to
  • substance abuse and Specifies the
    interventions to prevent the onset of
  • substance abuse.

25
Theories of Prevention
  • Cognitive-Affective
  • Social Learning
  • Intrapersonal
  • Comprehensive

26
Cognitive-Affective
  • Theory The consequences of experimenting with a
    drug contributes to decision to use.
  • Intervention Increase beliefs about negative
    consequences of drugs, highlight benefits of not
    using drugs, and correct inflated estimates or
    perceptions of drug use.

27
Social Learning
  • Theory Adolescents acquire their beliefs
    about substance use and other delinquent
    behaviors from their role models, friends, and
    parents.
  • Intervention Provide adolescents with
    positive role models, and to teach them refusal
    skills and the belief that they can resist drugs.

28
Conventional Commitment and Social Attachment
  • Theory Emotional attachments adolescents have
    with peers who use substances is the cause of
    substance use.
  • Intervention Improve bonds between
    adolescents and positive peer groups and
    prosocial institutions. Focus on improving
    academic and career skills, provide career
    opportunities, and teach parents how to socialize
    and reinforce their children.

29
Intrapersonal
  • Theory Examine how personality
    characteristics, emotions, and behavioral skills
    contribute to substance use. Examples stress at
    school, self-esteem, social interaction skills,
    coping skills, and emotional distress.
  • Interventions Target many of the individual
    characteristics of children rather than focusing
    on their beliefs about specific drugs and
    behaviors.

30
Comprehensive
  • Combines components from all of the other
    theories. They attempt to account for how
    adolescents' biology, personality, relationships
    with peers and parents, and culture or
    environment interact to cause drug use.

31
Conclusions Before selecting an approach,
consider the following
  • Who are the people in the support system?
  • Are they contributor to the adolescent's level of
    risk for using substances?
  • What are the adolescent's attitudes toward
    specific substances?
  • How might values communicated through an
    adolescent's culture influence decisions to
    experiment with substances?
  • What are the personality characteristics,
    emotional states, and/or behavioral skills of
    adolescents at risk for using substances?

32
Ecological Model
Individual
Peer/Family
Society
Community/Tribe
33
Individual Intervention
  • Identify risk and protective factors
  • counseling
  • skill building
  • improve coping
  • support groups
  • Increase community awareness
  • Access to hotlines other help resources

34
Effective Family Intervention Strategies
Critical Role of Families
  • Parent training
  • Family skills training
  • Family in-home support
  • Family therapy

Different types of family interventions are used
to modify different risk and protective factors.
35
Community Driven/School Based Prevention
Interventions
  • Public awareness and media campaigns
  • Youth Development Services
  • Social Interaction Skills Training Approaches
  • Mentoring Programs
  • Tutoring Programs
  • Rites of Passage Programs

36
Risk Factors
  • Exist in multiple domains.
  • The more risk factors present, the greater the
    risk.
  • Reducing the overall number can have a
    significant impact on future problem behaviors.
  • Show the same effect across different races,
    cultures and classes.
  • Can be buffered by protective factors.

37
Protective Factors
Individual is given
  • the opportunity for involvement in productive,
    pro-social roles in family, friends, community,
    society
  • the skills to be successfully involved in
    those roles
  • recognition and reinforcement for their
    involvement

38
Prevention Programs Reduce Risk Factors
  • ineffective parenting
  • chaotic home environment
  • lack of mutual attachments/nurturing
  • inappropriate behavior in the classroom
  • failure in school performance
  • poor social coping skills
  • affiliations with deviant peers
  • perceptions of approval of drug-using behaviors

39
Prevention Programs Enhance Protective Factors
  • strong family bonds
  • parental monitoring
  • parental involvement
  • success in school performance
  • pro social institutions (e.g. such as family,
  • school, and religious organizations)
  • conventional norms about
  • drug use

40
Prevention Programs Should . . . .
Target all Forms of Drug Use
. . .and be Culturally Sensitive
41
WHAT ARE SOME PROMISING STRATEGIES?
42
Integrated Treatment
  • Premise treatment at a single site, featuring
    coordination of treatment philosophy, services
    and timing of intervention will be more effective
    than a mix of discrete and loosely coordinated
    services
  • Findings
  • decrease in hospitalization
  • lessening of psychiatric and substance abuse
    severity
  • better engagement and retention
  • (Rosenthal et al,
    1992, 1995, 1997 Hellerstein et al 1995.)

43
Comprehensive School and Behavioral Health
Partnership
  • Prevention and behavioral health
    programs/services on site
  • Handling behavioral health crises
  • Responding appropriately and effectively after an
    event occurs

44
Treatment Approaches Effective withMethamphetamin
e Use Disorder
  • Motivational Interviewing - MI
  • Therapeutic Use of Urinalysis
  • Contingency Management (motivational incentives)
  • Community Reinforcement Approach
  • Cognitive Behavioral Therapy - CBT
  • Matrix Model (combination of above)

(Data show that methamphetamine treatment
outcomes are not very different than those for
other addictive drugs)
45
Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
46
Potential Organizational Partners
  • Law Enforcement
  • Juvenile Justice
  • Medical Examiner
  • Faith-Based
  • County, State, and Federal Agencies
  • Student Groups
  • Education
  • Family Survivors
  • Health/Public Health
  • Mental Health
  • Substance Abuse
  • Elders, traditional

47
Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org
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